Yotsukura Masaya, Muraoka Yuji, Yoshida Yukihiro, Nakagawa Kazuo, Shiraishi Kouya, Kohno Takashi, Yatabe Yasushi, Watanabe Shun-Ichi
Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan.
Ann Surg Oncol. 2023 Feb;30(2):851-858. doi: 10.1245/s10434-022-12621-x. Epub 2022 Oct 19.
The 8th edition of the TNM stage classification of lung cancer was developed based on an evaluation of the 5-year prognosis using an international database. Since recurrence after 5 years postoperatively is known to develop, the applicability of the stage classification beyond 5 years after treatment needs to be evaluated.
Postoperative prognosis and prognostic indicators were analyzed using data for 648 patients of pathological stage IA adenocarcinoma, who underwent complete resection between 2007 and 2012.
The median age was 66 years (interquartile range 60-73 years), and the median follow-up duration was 100 months (interquartile range 70-116 months). Overall survival probabilities for pathological stage IA1, IA2, and IA3 patients were 100%, 96.3%, and 91.5% at 5 postoperative years, and 94.2%, 89.8%, and 83.5% at 10 postoperative years, respectively (IA1 vs IA2: p = 0.05; IA2 vs IA3: p = 0.05). Multivariate analysis for overall survival of patients who survived without recurrence for 5 postoperative years revealed that age (hazard ratio 3.21, p = 0.02) was the only factor that was significantly associated with long-term survival. Stage classification (IA1, IA2, or IA3) was not an associated factor. The incidence of secondary primary lung cancer continued to increase, resulting in an estimated probability of 8.6% at 10 postoperative years.
For patients who survived without recurrence for 5 postoperative years, age, not stage classification, was associated with survival thereafter. The long-term follow-up strategy does not need to be modified according to the stage classification, and screening for secondary primary lung cancer should be considered.
肺癌TNM分期第8版是基于使用国际数据库对5年预后的评估而制定的。由于已知术后5年后会出现复发，因此需要评估治疗后5年以上分期的适用性。
对2007年至2012年间接受完全切除的648例病理分期为IA期腺癌患者的数据进行分析，以评估术后预后及预后指标。
中位年龄为66岁（四分位间距60 - 73岁），中位随访时间为100个月（四分位间距70 - 116个月）。病理分期为IA1、IA2和IA3期的患者术后5年的总生存概率分别为100%、96.3%和91.5%，术后10年分别为94.2%、89.8%和83.5%（IA1与IA2：p = 0.05；IA2与IA3：p = 0.05）。对术后5年无复发存活患者的总生存进行多因素分析显示，年龄（风险比3.21，p = 0.02）是唯一与长期生存显著相关的因素。分期（IA1、IA2或IA3）不是相关因素。继发性原发性肺癌的发病率持续上升，术后10年估计概率为8.6%。
对于术后5年无复发存活的患者，与后续生存相关的是年龄，而非分期。长期随访策略无需根据分期进行调整，应考虑对继发性原发性肺癌进行筛查。
